Laparoscopy Applications

Cholelithiasis definition

Cholelithiasis refers to the formation of gallstones, gallbladder removal surgery is very common in our setting, laparoscopic surgery replace open surgery or conventional, which years ago was done with incisions in the abdomen of several centimeters, with postoperative pain and more than a week of hospitalization. In laparoscopic surgery requires four wounds of a cm or less. The patient has little postoperative pain and rapid recovery.

Questions and answers about Cholelithiasis

Does Laparoscopic cholecystectomy is the operation for you?

Although the laparoscopic approach has many advantages, the operation may be appropriate for some patients if they have had previous abdominal surgery (which ever is less contraindication if the surgeon is skilled in laparoscopy) or who have any prior medical conditions. Surgeon's advice expert will answer all your queries, to determine if the gallbladder can be removed with surgery or laparoscopic

How safe is laparoscopic surgery?

The rate of complications of laparoscopic gallbladder surgery is low and comparable to traditional surgery, it must be performed by a surgeon trained and experienced in this type of surgery. The risks of laparoscopic cholecystectomy are less than leaving the gallbladder disease evolve and not to apply the surgical treatment

How the operation is performed laparoscopically?

A tube of 1 cm that is connected to a camera, which introduced into the abdominal cavity, emits magnified images of the abdominal organs on a television monitor. Other tubes allow the handling of surgical instruments for removal of the gallbladder and subsequent extraction.

How long will I be in the hospital?

Patients usually are discharged the day after the operation, in some cases even the same evening.

What happens after gallbladder surgery?

Removing the gallbladder is a major surgery and may feel abdominal pain, nausea and vomiting, once tolerated fluids and oral diet, patients leave the hospital. Overall recovery is gradual, but the presence of fever, maintenance of abdominal pain, distension of the abdomen or yellowing of the eyes or skin, are indicative of some type of complication and will need to consult with your surgeon as soon as possible.

When will normal life after surgery?

Majority of patients can return to normal working after a week, this time is related to the nature of their employment in the tape back a few days, in the case of manual activity time of incorporation is something more long

Laparoscopic Cholelithiasis surgery.

Laparoscopic cholecystectomy is currently the treatment of choice in most patients with symptomatic cholelithiasis, with clear advantages over traditional techniques, such as the reduction of postoperative pain with rapid initiation of oral intake and ambulation, allowing early discharge and a more rapid return to normal activity. It also provides better cosmetic results in the absence of abdominal scars or wounds.

Cholelithiasis laparoscopic technique.

Position of the patient.

Patient supine with legs abducted on leg and elevated 20 degrees in Antitrendelemburg, nasogastric tube and bladder during the operation.

Pneumoperitoneum.

Verres needle or open technique Hansson, at a pressure of 13 mmHg, through an incision paraumbilical, which serve for the first trocar from the viewpoint of the laparoscope.

Laparoscopic trocars.

Are inserted under direct vision: May 1 mm. midclavicular line right below the umbilical line, another of 10 mm. left upper quadrant outside the midline and finally the 5 mm. right subcostal, for probe-spacer of the liver in this condition can be replaced by the vacuum-tube laparoscopic lavage, facilitating the surgical procedure to keep the area clean. Be exceptional, need fifth trocar in the right upper quadrant, for intraoperative cholangiography.

Instrumental laparoscopic.

It is the same we use in the symptomatic cholelithiasis cholecystectomy in elective surgery, with two working channels and the surgeon between the patient's legs, operates with both hands simultaneously. After cholecystectomy the gallbladder is extracted by the gate cord.

Surgical technique.

Wall thickening of the gallbladder. Difficult or impossible to get "to prey" with laparoscopic forceps or a thick wall thickening calculation, impacted in the infundibulum, which erodes when the bile duct, produces biliary-biliary fistula.

The vesicle tension and enlarged. In cases of hydrops or empyema emptying transmural puncture using a needle of Verres or Palmer for easy handling with the forceps of the surgeon's left hand (French position) is essential for the identification, dissection and completion of cholecystectomy

Inflammation of the gallbladder wall. You can compress the bile duct (Mirizzi syndrome). Difficult dissection and identification of vesicular elements of the pedicle, it is impossible to differentiate the biliary vessels.

Perivesicular adhesions. They can set the gall to neighboring organs (hepatic flexure of the colon, duodenum, etc.) producing a "biliary-enteric fistula", in other cases when the greater omentum can produce bleeding, often yielding little substantial and spontaneously with the hyper of pneumoperitoneum.

Dissection of the cystic duct. It can be difficult because of anatomical abnormalities and what is most frequent inflammatory infiltration, the dissection must begin with the peritoneum of the posterior aspect of the pedicle, opening rear window vesicular pedicle facilitates the identification of the cystic duct and cystic which was subsequently ligated with clips, and then proceeded to their section. Sometimes we can find a large caliber cystic duct, which can not be obliterated with a clip only, employment and placement of more than one, staggered, can solve the problem. The placement of a ligature or an endo-loop, give more security to the closure of the cystic duct.

Identification and clipping of the cystic artery. In cases of cholecystitis, the cystic artery is usually short hindering their isolation, for proper clipping. It is important to consider that at this time of the operation, we should not sever the cystic artery, until we are convinced of their identification. Sometimes it can start the dissection of the gallbladder bed to see how it enters the artery wall.

The separation of the gallbladder from the liver bed. It is performed with electrocautery and scissors, without discarding the blunt dissection with a laparoscopic swab (similar to digital dissection in open surgery) The inflamed gallbladder removal, should be done in laparoscopic bag to avoid possible contamination of the abdominal cavity or skin-parietal route.

Postoperative complications.

Hemorrhagic.

Appear as a syndrome of intraperitoneal blood collection or internal bleeding, which in some cases justify the open or laparoscopic reoperation for the review of the operative field and hemostatic control.

Biliary fistula.

The etiology is dehiscence of the cystic duct clips or the existence of aberrant bile canaliculi, which go unnoticed in the operation. It will be convenient to detect any bile leak before the end of surgery.

Injuries of the gastrointestinal tract.

They usually occur in the hepatic flexure of the colon or duodenum that may be attached to the bottom vesicular by the inflammatory process, and that the maneuvers of dissection of the gallbladder, are drilled. Postoperative complications are more severe if the injury goes unnoticed.

Forgotten foreign bodies.

Metal clips may be lost in the peritoneal cavity do not cause any complications in the patient and his discovery will be in radiographs of the abdomen in a vacuum. Gallstones, gallbladder postrotura in acute cholecystitis, may be forgotten in the subhepatic space and even elsewhere in the abdomen, possible complications, depend on: stone size, number and polluting power of bile.

Parietal complications.

The abscess wall doors and especially the extraction of the gallbladder are rare, if one takes the precaution of removing the gallbladder in endobag. It is more common the existence of hematoma in the left upper quadrant door, unnoticed by vascular injury, it is important to avoid this complication removing all trocars under direct vision. Even the last, which is usually the left upper quadrant.